Microarray patch vaccines for typhoid conjugate vaccines: A global cost-effectiveness analysis

Area of Science:

• Global Health
• Vaccinology
• Health Economics

Background:

• The current typhoid conjugate vaccine (TCV) administered via needle and syringe (TCV-N&S) faces coverage limitations in hard-to-reach populations.
• A novel typhoid conjugate vaccine presentation, the microarray patch (TCV-MAP), is under development to potentially improve vaccine delivery and coverage.

Purpose of the Study:

• To evaluate the cost-effectiveness of TCV-MAPs compared to TCV-N&S alone.
• To assess the impact of TCV-MAPs on health outcomes and healthcare costs across 133 low- to upper-middle-income countries.

Main Methods:

• A global extended cost-effectiveness analysis was conducted from a healthcare perspective over 20 years (2033-2052).
• The analysis considered TCV-MAP costs 1.33 to 3 times higher than TCV-N&S.
• Incremental cost-effectiveness ratios were calculated and compared against cost-effectiveness thresholds, with subnational analyses performed for five countries.

Main Results:

• National rollout of TCV-MAPs could avert an additional 5.2 million cases, 47,000 deaths, and 2.4 million DALYs compared to TCV-N&S alone, at an additional cost of US$3.5 billion.
• TCV-MAPs demonstrated cost-effectiveness in 33% of countries studied, rising to 78% in sub-Saharan Africa.
• Subnational implementation of TCV-MAPs could avert 2-15% of cases for less than 1-3% of the additional cost compared to a national rollout, improving value.

Conclusions:

• TCV-MAPs present a potentially cost-effective strategy for increasing typhoid conjugate vaccine coverage, particularly in resource-limited settings.
• The price of TCV-MAPs is a critical factor; lower prices and strategic regional or subnational implementation enhance their value proposition.
• Targeted TCV-MAP deployment can significantly improve public health outcomes and reduce disease burden, especially in high-incidence regions like sub-Saharan Africa.